A
root canal is a treatment used to repair and save a tooth that is badly
decayed or becomes infected. During a root canal procedure, the nerve
and pulp is removed and the inside of the tooth is cleaned and sealed.
The
pulp or pulp chamber is the soft area within the center of the tooth.
The tooth’s nerve lies within root canals, which lie within the roots
or “legs” of the tooth. The root canals travel from the tip of the
tooth’s root into the pulp chamber, which also contains blood vessels
and connective tissue that nourish the tooth.
A tooth’s
nerve is not vitally important to a tooth’s health and function after
the tooth has emerged through the gums. Its only function is sensory –
to provide the sensation of hot or cold. The presence or absence of a
nerve will not affect the day-to-day functioning of the tooth.
Pricing
A
ballpark estimate for the price of root canal treatment itself (not
including a dental restoration following the procedure) performed by a
general dentist is $1100 for an incisor, $1100-1250 for a premolar and
$1400 to $1500 for a molar.
Why Does the Pulp Need to Be Removed?
When
nerve tissue or pulp is damaged, it breaks down and bacteria begin to
multiply within the pulp chamber. The bacteria and other decayed debris
can cause an infection or abscessed tooth. An abscess is a pus-filled
pocket that forms at the end of the roots of the tooth. An abscess
occurs when the infection spreads all the way past the ends of the
roots of the tooth. In addition to an abscess, an infection in the root
canal of a tooth can cause:
Swelling that may spread to other areas of the face, neck, or head
Bone loss around the tip of the root
Drainage
problems extending outward from the root. A hole can occur through the
side of the tooth with drainage into the gums or through the cheek with
drainage into the skin.
What Damages a Tooth’s Nerve and Pulp in the First Place?
Nerve
and pulp can become irritated, inflamed and infected due to deep decay,
repeated dental procedures on a tooth and/or large fillings, a crack or
chip in the tooth, or trauma to the face.
What Are the Signs that a Root Canal Is Needed?
Sometimes no symptoms are present; however, signs to look for include:
Severe toothache pain upon chewing or application of pressure
Prolonged sensitivity/pain to heat or cold temperatures (after the hot or cold has been removed)
Discoloration (a darkening) of the tooth
Swelling and tenderness in the nearby gum
A persistent or recurring pimple on the gums
What Happens During the Procedure?
A
root canal requires one or more office visits and can be performed by a
dentist or endodontist. An endodontist is a dentist who specializes in
the causes, diagnosis, prevention and treatment of diseases and
injuries of the human dental pulp or the nerve of the tooth. The choice
of which type of dentist to use depends to some degree on the
difficulty of the root canal procedure needed in your particular tooth
and the general dentist’s comfort level in working on your tooth. Your
dentist will discuss who might be best suited to perform the work in
your particular case.
The first step in the procedure is to take an X-ray to see
the shape of the root canals and determine if there are any signs of
infection in a surrounding bone. Your dentist will then use local
anesthesia to numb the area near the tooth. Anesthesia may not be
necessary, since the nerve is dead, but most dentists still anesthetize
the area to make the patient more relaxed and at ease.
Next,
to keep the area dry and free of saliva during treatment, your dentist
will place a rubber dam (a sheet of rubber) around the tooth.
An
access hole will then be drilled into the tooth. The pulp along with
bacteria, the decayed nerve tissue and related debris is removed from
the tooth. The cleaning out process is accomplished using root canal
files. A series of these files of increasing diameter are each
subsequently placed into the access hole and worked down the full
length of the tooth to scrape and scrub the sides of the root canals.
Water or sodium hypochlorite is used periodically to flush away the
debris.
Once the tooth is thoroughly cleaned, it is sealed.
Some dentists like to wait a week before sealing the tooth. For
instance, if there is an infection, your dentist may put a medication
inside the tooth to clear it up. Others may choose to seal the tooth
the same day it is cleaned out. If the root canal is not completed on
the same day, a temporary filling is placed in the exterior hole in the
tooth to keep contaminants out between appointments.
Rebuilding
At
the next appointment, to fill the interior of the tooth, a sealer paste
and a rubber compound called gutta percha is placed into the tooth’s
root canal. To fill the exterior access hole created at the beginning
of treatment, a filling is placed.
The final step may
involve further restoration of the tooth. Because a tooth that needs a
root canal often is one that has a large filling or extensive decay or
other weakness, a Crown or an Onlay or a large white filling often
needs to be placed on the tooth to protect it, prevent it from breaking
and restore it to full function. Your dentist will discuss the need for
any additional dental work with you.
Images below – optional extra treatment:
How Painful Is the Procedure?
Root
canal procedures have the reputation of being painful. Actually, most
people report that the procedure itself is no more painful than having
a filling placed. The reputation for pain is based around old
technology and techniques, the most common response is what, is that
all, are you finished? that was easy!
What Should One Expect After the Root Canal?
For
the first few days following the completion of treatment, the tooth may
feel sensitive due to natural tissue inflammation, especially if there
was pain or infection before the procedure. This sensitivity or
discomfort usually can be controlled with over-the-counter pain
medications such as ibuprofen (nuerofen) or Panadiene. Most patients
can return to their normal activities the next day.
Until
your root canal procedure is completely finished – that is to say, the
permanent filling is in place and/or the crown, it’s wise to minimize
chewing on the tooth under repair. This step will help avoid
recontamination of the interior of the tooth and also may prevent a
fragile tooth from breaking before the tooth can be fully restored.
As
far as oral health care is concerned, brush and floss as you regularly
would and see your dentist at normally scheduled intervals.
How Successful Are Root Canals?
Root
canal treatment is highly successful; the procedure has more than a 95%
success rate. Many teeth fixed with a root canal can last a lifetime.
Also, because the final step of the root canal procedure is application
of a restoration such as a crown or a filling, it will not be obvious
to onlookers that a root canal was performed.
Complications of a Root Canal
Despite
your dentist’s best efforts to clean and seal a tooth, new infections
might emerge. Among the likely reasons for this include:
More than the normally anticipated number of root canals in a tooth (leaving one of them un cleaned)
An undetected crack in the root of a tooth
A
defective or inadequate dental restoration that has allowed bacteria to
get past the restoration into the inner aspects of the tooth and re
contaminate the area
A breakdown of the inner sealing material over time, allowing bacteria to re contaminate the inner aspects of the tooth
During
treatment very delicate instruments are used to clean and shape the
tooth. Very occasionally these instruments can separate (break) in the
canals. This does not necessarily mean the entire treatment is a
failure. Most often the fractured piece can be removed or by-passed,
and a normal root filling placed. Sometimes the treatment is completed
leaving the piece of instrument in the root. Most often this is not a
problem. If the treatment does fail one can consider an alternate
surgical solution: either extracting the tooth or doing an apicoectomy
(cutting off the tip of the problem root and sealing it from the
outside).
Alternatives to a Root Canal
Saving your
natural teeth is the very best option, if possible. Your natural teeth
allow you to eat a wide variety of foods necessary to maintain proper
nutrition. The root canal procedure is the treatment of choice. The
only alternative to a root canal procedure is having the tooth
extracted and replaced with options for missing teeth to restore
chewing function and prevent adjacent teeth from shifting. These
alternatives not only are more expensive than a root canal procedure
but require more treatment time and additional procedures to adjacent
teeth and supporting tissues.
What happens if I dont have root canal treatment?
If
a tooth has an abscess it can firstly cause severe pain, but not
always. Some abscesses can be surprisingly painless. Nevertheless, the
infection at the root tips can spread into the surrounding bone and
soft tissues and cause more serious infections there that could cause
swelling and pain. Bacteria also enter the blood stream and can infect
other parts of the body. Prosthetic hip and knee joints and heart
valves are particularly prone to infection. Patients with other health
problems could also be at higher risk.
Root Canal Prevention
Since
some of the reasons why the nerve of a tooth and its pulp become
inflamed and infected are due to deep decay, repeated dental procedures
on a tooth and/or large fillings, following good oral hygiene practices
(brushing twice a day, flossing at least once a day, and scheduling
regular dental visits) may reduce the need for a root canal procedure.
Trauma resulting from a sports-related injury can be reduced by wearing
a mouth guard.
